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The 9 Factors that Predict Heart Attack

90% of heart attacks are determined by these modifiable risk factors


Updated October 25, 2004

By DrRich

Investigators now report that most heart attacks can be predicted by the presence of 9 controllable risk factors. This conclusion comes from the INTER-HEART study, one of the largest studies of its type ever conducted. Results from the INTER-HEART study were presented at the recent European Society of Cardiology Congress (2004).

This study looked at more than 29,000 individuals from around the world, roughly half of whom had had prior heart attacks (myocardial infarction). The other half had never had heart attacks. Investigators were able to identify in this population 9 modifiable risk factors that were associated with an increased risk of heart attack. Indeed, these 9 risk factors appeared responsible for over 90% of the heart attacks seen in these patients. Further, these same risk factors "worked" in predicting heart attacks for every racial and ethnic group in every region of the world.

The 9 risk factors were (in order of importance):

1) Increased LDL/HDL ratios (i.e.,, elevated LDL and low HDL levels)

2) Smoking

3) Diabetes

4) Hypertension

5) Abdominal obesity

6) Psychosocial (i.e., stress or depression)

7) Failure to eat fruits and vegetables daily

8) Failure to exercise

9) Failure to drink any alcohol

DrRich Comments:

Here are a few observations about this list of risk factors. The risk of heart attack for individuals who had all 9 of these factors, amazingly, was almost 130 times higher than for somebody with none of them. The first two of these risk factors (bad lipid readings and smoking) predicted 2/3 of all heart attacks. Smoking any form of tobacco (including cigars and pipes) increased risk, and the more tobacco an individual used, the higher the risk. Diabetes is considered a "controllable" risk factor on this list because, while type I diabetes is not preventable, the much more common type II diabetes is (with diet, exercise and weight loss). It is notable that abdominal obesity, but not obesity itself, made the list of 9. Obesity itself was found to increase risk, but it was abdominal obesity - excess fat predominantly stored in the belly - that really made a difference.

Finally, DrRich profusely apologizes in advance for the fact that not drinking alcohol made the list of 9 risk factors for heart attack. He acknowledges that this fact is certainly unfortunate (not to mention politically incorrect,) and realizes that any information that encourages people to drink may very well cause more ultimate harm than good. Further, he recalls with some pain the large volume of angry e-mails with which he is inundated each time he (reluctantly) reports yet another new study suggesting that a little alcohol is good for the heart. He hereby promises to to re-read this very day these unflattering e-mail messages from the past, with the hope that as a result readers will find it unnecessary to unleash yet another flood of nastygrams.

You can read about cardiac risk factors and how to control them, here.

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